What is the recommended management for a patient with mumps, considering their vaccination status and medical history?

Management of Mumps

Mumps management is primarily supportive care with strict isolation protocols, symptomatic treatment, and vigilant monitoring for complications, particularly in adults who face higher complication rates. 1, 2

Immediate Isolation and Infection Control

• Implement droplet precautions immediately upon diagnosis and isolate the patient for 5 days after parotitis onset, as patients remain contagious from 7 days before through 8 days after symptom onset 1, 2
• Educate patients and family members that transmission occurs through respiratory droplets and direct contact with saliva 1, 2
• This isolation period is critical even in vaccinated individuals, as breakthrough infections occur and 44% of cases in the 2006 U.S. outbreak occurred in persons with at least 2 vaccine doses 1

Symptomatic Treatment Protocol

• Provide acetaminophen or NSAIDs for pain and fever control to manage fever, headache, and parotid gland pain 1, 2
• Ensure adequate hydration and fluid intake, as parotitis makes swallowing uncomfortable and painful 1, 2
• Recommend soft foods and strict avoidance of acidic foods that stimulate salivary flow and worsen parotid pain 1, 2
• The disease is self-limiting, with most patients recovering without intervention beyond these supportive measures 2

Complication Monitoring by System

Neurological Complications (Monitor Closely)

• Watch for aseptic meningitis (occurs in 4-6% of cases): severe headache, neck stiffness, photophobia, or altered mental status 1, 2
• Monitor for encephalitis signs including seizures, paralysis, or cranial nerve palsies, which can cause permanent neurological sequelae 1, 2
• Assess for hearing loss, including sudden sensorineural deafness, which was historically a major cause of childhood deafness pre-vaccination 1, 2

Reproductive System Complications (Age-Dependent)

• In postpubertal males, assess for orchitis (occurs in up to 38% of cases): testicular pain and swelling typically developing 10 days after parotitis 1, 2, 3
• Reassure patients that sterility is rare despite the high orchitis incidence 1, 2
• In postpubertal females, monitor for oophoritis (ovarian inflammation) 1, 2
• Complications are significantly more common and severe in adults than children, making age a critical factor in monitoring intensity 2, 4

Other Systemic Complications

• Watch for pancreatitis: severe abdominal pain, nausea, and vomiting 1, 2

Special Intervention: Facial Nerve Involvement

• If facial nerve inflammation with weakness develops, initiate prednisone 1-2 mg/kg/day for 5-7 days followed by a 5-7 day taper 1, 2
• Provide eye protection to prevent corneal damage in patients with facial weakness 1, 2
• Reassure patients that complete recovery occurs in approximately 70-80% of cases within 3-6 months 1, 2

Post-Recovery Vaccination Considerations

• Adults born during or after 1957 without documentation of vaccination, laboratory evidence of immunity, or physician-diagnosed mumps should receive MMR vaccine after complete recovery 1
• A second MMR dose is recommended for adults in outbreak settings, postsecondary students, healthcare workers, or international travelers 1
• Do not administer MMR vaccine during acute illness; wait until recovery is complete 1
• Consider a third dose during outbreak settings for high-risk populations, though this is not routinely recommended by the CDC 1

Critical Clinical Caveats

• Only 30-40% of mumps infections produce typical acute parotitis; 15-20% are asymptomatic and up to 50% present with nonspecific or respiratory symptoms 1, 2
• This atypical presentation means mumps should remain on the differential for fever and malaise even without parotid swelling 2, 4
• Mumps can occur in highly vaccinated populations due to waning immunity, particularly in crowded environments like college dormitories 1, 5
• Women who develop mumps during the first trimester have an increased risk for fetal death 4